Mitigate ICD-10 impact

Impact analysis and monitoring to reduce financial impact.

ICD-10

The migration from ICD-9 to ICD-10 has forced the modification of many processes and policies, including benefits, provider contracting and medical management. Even after the transition date, organizations will need to continuously assess and manage financial and operational impacts in order to maintain neutrality. Analytics are the foundation for post transition risk mitigation planning and offer strategic insights into scaling adoption across lines of business.

Our Approach

Edifecs ICD-10 solutions and services allow organizations to embrace an iterative approach to analytics and remediation. Identify and quantify real-world risk both during the migration to ICD-10 and after the transition, using business intelligence tools.

Organizations then use their own data, standard and organization-specific ICD-9 to ICD-10 maps and MS- and APR-DRG groupers to compare results to better manage financial, operational and relationship risks.

Capabilities

Impact analytics

Financial impact is key to a successful ICD-10 transition. Edifecs Impact analytics automates the identification and visualization of relationships between historical ICD-9 claims and their potential ICD-10 matches, allowing you to quickly analyze and compare financial impacts of MS-DRG outcomes.

  • Identify/measure DRG shifts and determine the associated effects on reimbursement.
  • Impact of coding guideline changes, combination codes and comorbid condition changes.
  • Identify and measure DRG shifts. Determine the associated effects on reimbursement.
  • Address risk, prioritize high volume, high impact areas and begin addressing these first.
  • Collaborate with trading partners to improve predictability of reimbursement.

Code management

Accelerate and improve the accuracy of ICD-10 mapping. Edifecs ICD-10 Code Management is a patented web-based code mapping application that allows healthcare organizations to rapidly create, version and publish customized mappings between ICD-9 and ICD-10 code sets.

  • Clinically relevant maps that combine Edifecs’ patented medical ontology and GEMS.
  • Create accurate crosswalks between codesets and publish bi-directional mappings.
  • Streamline mapping process to remediate medical policies and benefits conversion.
  • Accelerates mapping activity using intuitive user interface and mapping wizard.
  • Test code translation by simulating code translation behavior in the user interface.

Health check services

Edifecs ICD-10 Program Health Check utilizes a combination of technology and process driven methodology to define and benchmark clinical, financial and operational risk. Then, our consultants create a dynamic monitoring framework that helps you manage risks, operationalize policy and monitor benefits.

  • Edifecs offers ICD-10 consulting for payers, providers and states organizations.
  • We have numerous marquee customer references and implementation success cases.
  • Mapping services are available to build and test functional maps between code sets.
  • Policy and benefit management services for remediation and benefits conversion.